Full range of orthopedic services from diagnosis to rehabilitation. We provide assistance with injuries and diseases of the joints, as well as sports injuries.
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Super Inductive System
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De Quervain’s disease is a common cause of pain on the thumb side of the hand and along the radial side of the wrist. It can interfere with gripping, limit everyday hand movements, and often becomes noticeable during routine activities, sports, or heavy physical work.
In this article, we explain what causes the condition, which symptoms are considered typical, how diagnosis and treatment are performed, and when a doctor may recommend surgery.
What Is De Quervain’s Disease?
De Quervain’s disease, also known as De Quervain’s tenosynovitis, is a condition affecting the first extensor compartment of the wrist. The thumb tendons pass through a narrowed tunnel and begin to glide with pain.
The condition is also described as stenosing tenosynovitis. The tendon sheath thickens near the radial side of the wrist, the fibrous tunnel becomes narrower, and every movement of the thumb increases friction. This leads to pain at the base of the thumb, tenderness on palpation, and a gradual reduction in hand function.
The two tendons most commonly affected are:
abductor pollicis longus;
extensor pollicis brevis.
They extend from the forearm to the hand and are responsible for moving the thumb away from the hand and straightening it without moving the tip of the thumb. When the tunnel becomes narrowed, the tendons begin to move against mechanical resistance. For this reason, pain usually becomes worse when moving the thumb, bending the wrist sideways, or gripping objects firmly.
Main Causes of De Quervain’s Disease
The condition is not always caused by an injury. Most often, it is associated with:
repetitive strain on the hand;
frequent thumb movements;
forceful gripping;
lifting objects;
twisting the wrist;
work that requires the hands to remain in the same position for long periods.
Additional risk factors include pregnancy, the postpartum period, rheumatoid arthritis, and manual work involving repeated wrist strain.
In everyday life, the condition often develops in people who frequently carry a baby, use hand tools, perform repeated gripping and thumb abduction, or make the same hand movements throughout the day.
Without appropriate load modification, tendon irritation may persist for a long time. This maintains inflammation, causes thickening of the tendon sheath, and leads to further narrowing of the tunnel.
Symptoms of De Quervain’s Disease
Symptoms usually develop gradually. At first, a person may notice discomfort on the side of the wrist. Over time, the pain becomes more pronounced, soft tissue swelling may appear, and hand movements become more difficult. A typical feature of this condition is that pain is triggered by activity, such as gripping, twisting, squeezing, or lifting objects.
Pain in the Thumb and Wrist Area
The main symptom is pain on the thumb side of the wrist. It may initially remain localized but can gradually spread into the forearm. Patients often experience tenderness over the area where the tendons pass through the tunnel, as well as a feeling that thumb movement has become less smooth.
In De Quervain’s disease, pain typically becomes worse when:
making a fist;
moving the thumb away from the hand;
rotating the wrist;
trying to grip an object firmly.
As a result, simple activities such as opening a jar, lifting a kettle, or holding a phone may become painful.
Swelling and Limited Hand Movement
Another common symptom is localized swelling along the radial side of the wrist. Sometimes it appears as mild soft tissue swelling, while in other cases there is visible thickening that makes it more difficult to move the thumb or bend the wrist sideways.
Pinch grip strength may also decrease, and the hand may function less effectively during everyday activities. The range of motion around the thumb joint becomes limited because of pain rather than bone deformity.This distinction is important during diagnosis because the doctor must differentiate De Quervain’s disease from osteoarthritis at the base of the thumb and other causes of wrist and hand pain.
Increased Pain During Activity
Pain may become significantly worse during activity, especially when squeezing, pulling, lifting something in front of the body, or bending the wrist toward the little finger. For this reason, symptoms are often more severe by the end of the day or after repeated hand movements.
Typical complaints may occur while caring for a baby or working with a screwdriver, pruning shears, scissors, or other tools. If pain becomes worse during heavy physical work or even while holding a cup, a medical evaluation is recommended.
How De Quervain’s Disease Is Diagnosed
Diagnosis is mainly clinical. An orthopedic specialist or hand surgeon asks about:
how the pain began;
the type of strain placed on the hand;
how long the symptoms have been present;
the condition of the wrist area;
tenderness on palpation;
the pattern of thumb movement.
The Finkelstein and Eichhoff tests are commonly used during diagnosis. The patient places the thumb inside the palm, closes the other fingers over it, and bends the wrist toward the little finger. If this movement causes sharp pain over the radial side of the wrist, the test supports the diagnosis.
X-ray imaging is usually not required. It may be ordered to rule out other conditions, such as osteoarthritis or the consequences of an injury. Soft tissue ultrasound may be used when the clinical presentation is atypical, when the condition of the tendons needs to be assessed more precisely, or before injection or surgical treatment.
Treatment Methods for De Quervain’s Disease
Treatment depends on how long the symptoms have been present, the severity of pain, the degree of functional limitation, and how the patient uses the hand at work and in everyday life. In the early stages, treatment usually begins with conservative methods. If pain persists, quickly returns, or significantly interferes with hand function, surgery may be considered.
Conservative Treatment and Reducing Hand Strain
The first step is to reduce the activities that trigger pain. Patients are advised to temporarily avoid:
forceful pinch grip;
repeated thumb abduction;
twisting the wrist;
prolonged use of hand tools.
A brace or splint may also be prescribed to keep the thumb and wrist in a more neutral position. This reduces friction between the tendons within the tunnel.
In the early stages, this approach may provide noticeable relief within four to six weeks. However, it is more effective when the patient genuinely changes the pattern of hand use rather than wearing the brace for only a few hours a day.
Medication and Physiotherapy
Nonsteroidal anti-inflammatory medications may be recommended to control pain and swelling. If symptoms persist, one of the most effective treatment options is a corticosteroid injection into the area of the tendon sheath. One or two injections provide significant relief for many patients.
Physiotherapy in this situation focuses on restoring functional hand movement. The patient may be taught:
how to reduce tendon irritation;
how to modify everyday gripping patterns;
when exercises can be introduced;
how to return to activity safely.
When necessary, a physiotherapist or occupational therapist selects exercises for the hand, wrist, and forearm to reduce pain, maintain mobility, and prevent repeated overloading.
Hand Surgery for De Quervain’s Disease
Surgical treatment is considered when conservative methods do not provide sufficient relief. The procedure involves releasing the sheath of the first dorsal compartment to relieve pressure on the tendons. After the release, the tendons can glide more freely, and the pain decreases.
The operation is usually performed on an outpatient basis and does not require a prolonged hospital stay. Surgery does not change the function of the thumb itself. It removes the mechanical restriction that prevents the tendons from moving normally.
When Surgery Is Necessary
Surgery is not required in every case. However, a doctor may recommend it in the following situations:
pain persists despite using a brace, modifying activity, and trying other conservative treatment methods;
symptoms are severe from the beginning and significantly interfere with hand function at home or at work;
injection treatment does not provide sufficient relief or the effect is short-lived;
there is a persistent limitation of hand function that makes everyday activities difficult.
The decision is made after a medical examination. The doctor considers the duration of the condition, previous treatment, the location of pain, and the patient’s actual functional needs.
Recovery After Treatment
After conservative treatment, recovery usually focuses on three main elements:
temporary use of a thumb and wrist brace;
reducing movements that trigger pain;
gradually restoring mobility.
Once acute inflammation decreases, gentle thumb abduction and extension exercises, light wrist mobilization, and correction of everyday gripping techniques may be introduced to avoid repeated tendon overload. When treatment begins early, symptoms often improve noticeably within four to six weeks.
After surgery, the hand is usually bandaged for the first 48 hours or several days. The patient then begins moving the fingers, thumb, and wrist to prevent stiffness. During recovery, the wound is monitored, swelling is reduced, and pain medication may be used when necessary. A follow-up examination is usually scheduled after 10 to 14 days, when the sutures are removed if they are not absorbable.
If movement remains limited, the doctor may recommend physiotherapy or hand therapy to restore range of motion, grip strength, and a safe return to normal activity.
Prevention of De Quervain’s Disease
Prevention is based on controlling strain on the wrist and thumb. If work or everyday activities regularly involve forceful gripping, wrist twisting, or repetitive movements, it is useful to take regular breaks, adjust gripping techniques, avoid keeping the thumb in an abducted position for long periods, and pay attention to the first symptoms. This is especially important for people who perform manual work, care for an infant, or have previously experienced similar wrist pain.
If pain appears near the base of the thumb, soft tissue swelling develops, the area becomes tender on palpation, or symptoms worsen during activity, it is better not to wait until the condition becomes chronic. Early diagnosis helps the doctor select appropriate treatment sooner and may reduce the need for surgery.
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